胸部手术后硬膜外镇痛对皮质醇IL-6 TNF的影响  

RESPONSES OF CORTISOL AND IL-6 AND TNF DURING AND AFTER THORACIC SURGERY EITH PATIENT-CONTROLLED EPIDURAL ANALGESIA

作　　者：高淑文[1] 张孟元[1] 蔡新力[1] 

机构地区：[1]山东省立医院

出　　处：《济宁医学院学报》2001年第3期24-25,共2页Journal of Jining Medical University

摘　　要：目的　观察开胸手术后硬膜外镇痛对病人神经内分泌、免疫反应的影响。方法　根据术后不同的镇痛方法 ,将 30例静吸复合麻醉下开胸手术病人随机分为 3组 ,硬膜外吗啡镇痛组 (A组 )、硬膜外布比卡因镇痛组 (B组 )、肌注哌替啶组 (对照组 ) ,每组 10例。比较 3组术后镇痛的效果。检测术前、手术 1h、术毕、术后 2 4h血浆皮质醇、TNF和IL - 6浓度的变化。结果　硬膜外吗啡或布比卡因都能产生良好的术后镇痛效果 ,病人满意度高 :VAS评分A组 1.5 3± 0 .64、B组 2 .0 3± 0 .34 ,均明显低于对照组 6.85± 2 .68(P <0 .0 1)。 3组病人血浆皮质醇浓度在手术 1h、术毕均比术前升高 (P <0 .0 1) ,术后 2 4h 3组仍高于术前水平 ,但A组和B组明显低于对照组 (P <0 .0 1)。A组和B组术后 2 4h血浆TNF浓度虽然较术前高 ,但无统计学差异 ;对照组 2 4hTNF浓度不但明显高于术前 (P <0 .0 1)而且高于A组 (P <0 .0 1)和B组 (P <0 .0 5 )。 3组IL - 6均于手术结束时升高 (P <0 .0 5～ 0 .0 1) ,但组间比较均无差异显著性 ;术后 2 4hIL - 6水平A组和B组有所回落 ,但A组仍高于术前值 (P <0 .0 5 ) ,而对照组却继续升高 ,与术前比较 ,差异显著 (P <0 .0 1) ,与A组和B组比较有差异性 (P <0 .0 5 )。Objective To research the effects of patient-controlled epidural analgesia(PCEA) after thoracic surgery on endocrine and some cytokins.Methods Thirty adult patients,ASA grade Ⅱ～Ⅲ,scheduled for elective thoracic surgery under general anesthesia,were designed to receive epidural morphine(group A),or bupivacaine(group B),or intramuscular pethidine (control group,group C)for postoperative analgesia,ten cases in each group.Pain relief was assessed with visual analog scale(VAS) and side effects were also recorded.Plasma cortisol,IL-6 and TNF were assayed at various times.Results Satisfactory pain relief achieved similarly in group A(VAS 1.53±0.64)and group B(VAS 2.03±0.34),but not in group C(VAS 6.85±2.68).Plasma cortisol level increased significantly(P<0.01)lh after incision compared to pre-operation in each group,but it was lower in group A and B than group C at 24h post-operation.Plasma TNF changes were less significant in group A(P<0.01)and group B(P<0.05)than that in group C at 24 hour post-operation. Tnterleukin 6(IL-6) gradually elevated in each group at the end of surgery.It significantly increased in group C compared to the concentration before operation (P<0.01)and the other two groups (P<0.05) at 24h post-operation.Conclusion The results of the study suggeseted that general anesthesia can not reduce the stress reaction during thoracic surgery,PCEA with either morphine or bupivacaine after thoracic surgery can supply satisfactory pain relief and reduce(at least in part)postoperative stress reaction both in endocrine and cytokins.

关 键 词：麻醉 应激反应 皮质醇 TNF IL-6 胸部外科手术 硬膜外镇痛 

分 类 号：R655[医药卫生—外科学] R614.42[医药卫生—临床医学]